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Chapter 23 Angina Sample Questions

1. JMP is a 60-year-old man with stable angina using metoprolol succinate 50 mg twice daily. Other medical condition is significant for chronic obstructive pulmonary disease (COPD). He presents to his family doctor with COPD exacerbations. His physician believes that the COPD exacerbations are associated with the use of high dose metoprolol succinate. Medication history indicates that he used to be on isosorbide dinitrate but was discontinued because of occasional use of sildenafil on as needed basis. What other therapies can be considered for JMP for the treatment of angina? *

A. Lisinopril
B. Telmisartan
C. Amlodipine
D. Nitrates transdermal patch

Answer

Ans: C

Tips: Beta-blockers are the first line therapy for the treatment of angina. Many patients with respiratory diseases like asthma and COPD cannot tolerate these drugs. As in JMP’s case, COPD was exacerbated by the use of a beta-blocker thus, switching to calcium channel blockers amlodipine is an appropriate alternative. Current guidelines suggest that if beta-blockers are contraindicated or side effects are not tolerated, for angina relief calcium channel blockers are good alternative. Patient is using sildenafil, so nitrates are not suitable option.

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